An Effective Curriculum for Focused Assessment Diagnostic Echocardiography: Establishing the Learning Curve in Surgical Residents

BackgroundSimulation training and competency-based assessment are the evolving standard for surgical education. The Focused Assessment Diagnostic Echocardiography (FADE) examination is a bedside, limited transthoracic ultrasound to assess cardiac function, anatomy, and volume status. FADE can be used to noninvasively evaluate and guide resuscitation of critically ill patients. The purpose of this study was to determine the learning curve for surgical residents to perform and interpret the results of the FADE examination using simulation and competency-based assessment.MethodsNovice surgical residents were enrolled in a FADE curriculum prospectively. The curriculum involved 4 successive sessions of 45 minutes of simulation followed by 5 FADE examinations on surgical intensive care unit patients. Examination performance was evaluated using a standardized scoresheet (15 points total) and plotted by session. Independent and paired t test and linear regression were used for statistical analysis.ResultsIn total, 20 individuals completed 390 FADE examinations. Performance increased from 45 ± 13% accuracy in the first session to 89 ± 9% accuracy in the fourth session (p < 0.001 between all sessions). Accuracy at central venous pressure prediction reached 88% by the final session (p < 0.001). Independent predictors of score included proportion of curriculum completed (odds ratio = 2.2; 95% confidence interval: 2.0-2.3; p < 0.001) and examination of thoracic surgery patients (odds ratio = 0.2; 95% confidence interval: 0.01-0.4; p = 0.04).ConclusionSurgical residents are able to achieve proficiency at performing and interpreting the results of FADE examination and predicting central venous pressure. Residents achieved mastery of evaluation of ventricular function, pericardial assessment, and volume status after 4 training sessions. The ability to teach surgical residents the use of the FADE examination can guide resuscitation without invasive monitoring.